A framework and analytical exploration for a data-driven update of the Sequential Organ Failure Assessment (SOFA) score in sepsis

Objective: The Sepsis-3 consensus statement emphasised the need for data-based approaches to organ failure assessment and use the Sequential Organ Failure Assessment (SOFA) for this purpose. We aimed to develop a framework for a data-driven update to the SOFA score for patients with sepsis. Design: Systematic analysis of potential markers of organ dysfunction in a retrospective, observational study. Setting: Intensive care units from three tertiary hospital centres in the United States, the Netherlands, and Austria were included in the study. Participants: 28 100 American, 5339 Dutch, and 2450 Austrian patients with suspected sepsis were included in this study. Measurements and main results: We assessed 56 organ function variables. We applied area under curve maximisation procedures to optimise the predictive power for mortality. We chose the most predictive biomarker for existing organ dysfunction domains and added a metabolic domain. We compared the area under the receiver operating characteristic curve and the area under the precision recall curve of the data-driven approach against the current SOFA system. The novel approach outperformed the current SOFA in all domains and databases (the area under the receiver operating characteristic curve: for US patients: 0.766 vs. 0.727, mortality: 10.7%; for Dutch patients: 0.70 vs. 0.653, mortality: 22.0%; for Austrian patients: 0.704 vs. 0.665, mortality: 22.0%; all p < 0.01 for the best performing score). The precision-recall curve confirmed such observations. Conclusions: We developed and validated a framework for a data-driven update to the SOFA to identify and classify organ dysfunction in suspected septic patients. This framework can be used to revise the SOFA score and its application to the identification and classification of sepsis. (c) 2025 The Authors. Published by Elsevier B.V. on behalf of College of Intensive Care Medicine of Australia and New Zealand. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).